The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

AROM (Artificial Rupture of Membranes)

See also:

• Being Born in the Caul

Subsections on this page:

• General Safety of AROM
• Variable Decels after AROM
• AROM Increases Risk of Infection
• AROM and Cord Prolapse
• AROM and PIH
• AROM Technique

General Safety of AROM

When is it Safe to Rupture Membranes?

Variable Decels after AROM

How many times have you seen variables after AROM? I try to make it a practice not to AROM unless absolutely necessary.

One of my ND friends used to AROM at six centimeters. He had been taught that this resulted in shorter labors and less FTP, so he practiced as he had been educated to do.....

We had some L-O-N-G discussions about AROM and shared stories and data and he began to leave the membranes be. His problem-labor rate, lousy-FHT rate, meconium rate, resuscitation rate, and his transport rate have ALL FALLEN since he made this simple change!

An old quote says "The baby is unlikely to get into trouble in labor as long as the membranes are intact".

I agree with you -- don't ROM unless absolutely necessary!

AROM Increases Risk of Infection

I wondered if anybody could help me out with this. I have a copy of the midwife's notes from our birth. Part of the reason we were transferred from home to hospital was because I developed a high fever shortly after AROM at home. The notes say that, between 4am and 10:30 am when we transported, 7 vaginal exams were performed ( 2 after ARM). At least 4 were done at the hospital, on top of those 7. When I protested to the exams(specifically after my membranes were ruptured), both the midwife and OB at the hospital said they were using sterile gloves.

My daughter was hospitalised for "possible sepsis" and I had a diagnosis of "possible chorioamnionitis". What is with all these "possibles"? Can anyone tell me if it sounds like these possible infections could have been caused by the AROM and exams? Amniotic fluid was clear and odorless when membranes were ruptured.

Well, that's nice that they used sterile gloves, but even they know that sterile gloves can still bring germs up from the outside world to your cervix.

The diagnoses of possible sepsis and possible chorioamnionitis may have been made solely on the basis of your high temperature. If the baby was hospitalized for possible sepsis, they almost certainly did a myriad of cultures (usually all orifices and a spinal tap.

About vag. exams and AROM - If they wanted you to get to it, they'd have put it in a much easier place to find.

This is the most profound wisdom I've heard in a long time. Thank you so much. I find myself partly laughing at the humor, but mostly delighted at the simple wisdom.

I figure the reason God/dess gave me such short fingers is so that I wouldn't be tempted to mess with the cervix all the time.

AROM and Cord Prolapse

Rupture of Membranes Causes Cord Prolapse

I've only heard about this - never tried it myself. But people say you can simply move the baby's head into the pelvis by applying pressure on the baby's butt and/or fundus to move it into the pelvis and prevent cord prolapse as the waters are broken.

Another possibility is to get the woman into a hands & knees posture while breaking the waters so that any loose cord will "sink" towards the fundus. Then try to move the head into the pelvis and or wait for the cervix to shrink up around the head after the waters are out before getting the mom back into an upright position.

These are the things that homebirth midwives talk about to prevent prolapse when they break waters with a high head, as a last resort, of course.

AROM and PIH

Does it make any sense that AROM would lower the mom's blood pressure or otherwise reduce risks of PIH?

Absolutely none I can think of.

NO IT DOES NOT>>>UNLESS YOU LIKE THE LOW BP OF SEPSIS!

unable to see what mechanism would be operant here. I've never heard this one.

I agree with you and I can only say that I have observed that the BP does go down.  What the action is-- and why it happens and if it really happens is unproven.  Just more of that old midwifery folklore.

I have seen many moms with PIH lower their BP once they go into labor, and others get higher. I can't see how AROM would have a direct affect on the PIH other than by inducing labor.

I think the goal of AROM in a PIH woman is simply to deliver her, thereby reducing the potential effects of PIH if the woman stays pregnant.  However, I have heard a couple of midwives' views that if a woman has elevated BP, THEY believe that AROM might not only cause her to deliver, but it also reduces, in their opinions, the extra fluid "pressure" on her body which can lower the BP. I have no experience in this, but AROM is usually the last thing I would want to do in a homebirth situation.

This is purely anecdotal, but my BP skyrocketed AFTER my water broke with my last baby - Water broke on her due date -- my cervix was completely unripe--hard, high (-5), closed.  In the 2 days after my water broke and before I was induced it got to 170/120.  Labor went really fast with induction, though!

AROM Technique

I love the MemCot: It's like a finger cot, with a firm plastic disc on the fingertip that has a pointy plastic bristle.  Much less intimidating to the mom than using a long pointed device such as the Amni-Hook.  I got mine from Cascade - item # 5696.